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All the knowledge I possess everyone else can acquire, but my heart is all my own. Johann Wolfgang von Goethe The Sorrows of Young Werther 1774

Types of cardiovascular disease


Deaths from cardiovascular diseases (CVD)
Number of deaths globally per year from different types of CVD, by age Highest numbers shown 2002 coronary heart disease stroke other cardiovascular diseases hypertensive heart disease inflammatory heart disease rheumatic heart disease

2 265 824

The human heart is only the size of a fist, but it is the strongest muscle in the human body. The heart starts to beat in the uterus long before birth, usually by 21 to 28 days after conception. The average heart beats about 100 000 times daily or about two and a half billion times over a 70 year lifetime. With every heartbeat, the heart pumps blood around the body. It beats approximately 70 times a minute, although this rate can double during exercise or at times of extreme emotion. Blood is pumped out from the left chambers of the heart. It is transported through arteries of ever-decreasing size, finally reaching the capillaries in all the tissues, such as the skin and other body organs. Having delivered its oxygen and nutrients and having collected waste products, blood is brought back to the right chambers of the heart through a system of ever-enlarging veins. During the circulation through the liver, waste products are removed. This remarkable system is vulnerable to breakdown and assault from a variety of factors, many of which can be prevented and treated. Risk factors will be explored on pages 2443.

1 868 339

996 183

280 819

104 116 66 542

04 years

514

1529

3044

4559

6069

7079

80+ years

Stroke Strokes are caused by disruption of the blood supply to the brain. This may result from either blockage (ischaemic stroke) or rupture of a blood vessel (haemorrhagic stroke). Coron Risk factors High blood pressure, atrial fibrillation (a heart ar disea y heart Coronary heart disease se ki rhythm disorder), high blood cholesterol, tobacco use, lls mor Disease of the blood vessels unhealthy diet, physical inactivity, diabetes, 7 mil e than lion supplying the heart muscle. peopl each and advancing age. e ye Major risk factors High blood pressure, strok ar, and es ki nearl high blood cholesterol, tobacco use, ll y 6 m ill Most unhealthy diet, physical inactivity, of th ion. ese death diabetes, advancing age, inherited s a devel re in (genetic) disposition. o count ping ries. Other risk factors Poverty, low educational status, poor mental health (depression), inflammation and blood clotting disorders. Aortic aneurysm and dissection Rheumatic heart disease Dilatation and rupture Damage to the heart muscle and heart of the aorta. valves from rheumatic fever, caused by Risk factors Advancing age, longstreptococcal bacteria. standing high blood pressure, Marfan syndrome, Congenital heart disease congenital heart disorders, Malformations of heart structures syphilis, and other existing at birth may be caused by infectious and genetic factors or by adverse inflammatory exposures during gestation. disorders. Examples are holes in the heart, abnormal valves, and abnormal heart chambers. Risk factors Maternal alcohol use, medicines (for example thalidomide, warfarin) used by the expectant Peripheral arterial disease mother, maternal infections such as rubella, Disease of the arteries poor maternal nutrition (low intake of folate), supplying the arms and legs. close blood relationship between parents Risk factors As for (consanguinity). coronary heart disease. Other cardiovascular diseases Tumours of the heart; vascular tumours of the brain; disorders of heart muscle (cardiomyopathy); heart valve diseases; disorders of the lining of the heart. Deep venous thrombosis (DVT) and pulmonary embolism Blood clots in the leg veins, which can dislodge and move to the heart and lungs. Risk factors Surgery, obesity, cancer, previous episode of DVT, recent childbirth, use of oral contraceptive and hormone replacement therapy, long periods of immobility, for example while travelling, high homocysteine levels in the blood.

Global deaths from CVD


millions 2002 total deaths: 16.7 million inflammatory heart disease
0.4m

rheumatic heart disease


0.3m

hypertensive heart disease


0.9m

stroke
5.5m

other forms of heart disease


2.4m

Other factors that can damage the heart and blood vessel system Inflammation, drugs, high blood pressure, unhealthy diet, trauma, toxins and alcohol.

coronary heart disease

18

7.2m

19